Day 10: Hot!

I was able to keep the water temperature above 105 for the entire bath this time.
What do I do while I'm on the pot for 45 minutes? Currently, I'm reading Overdiagnosed by Gilbert Welch. It is about the harms of turning well people into sick people by over-aggressive screening.

My favorite (and most clinically relevant) chapter so far is on incidentalomas. This is a cheeky bit of medical slang for incidental lesions found on imaging studies, when you were looking for something else. For example, you order a CAT scan to rule out appendicitis. The appendix looks fine, but there's a cyst in the liver! Then as a doctor you have to decide what to do with that information.

I had a wonderful example of an incidentaloma yesterday. A patient had a MRI of her low back because of back pain. The study showed stuff wrong with her lumbar disks (not surprising). But it also showed something in her pelvis. The radiologist said it was either a cystic ovarian mass, or fluid in a loop of bowel. He recommended an ultrasound.

As Overdiagnosed would point out, there is no proven benefit to screening for ovarian cancer. There's a lot of potential harm here. An incidentaloma is not screening. It has even less value. At least with screening, you started out purposefully looking for cancer.

What if I get an ultrasound, it finds a mass, she gets surgery for it, has complications like an abdominal infection? And the mass could still turn out to be benign.

So do I take the patient down this very dangerous road, with high chance of harm, and low chance of benefit, for something that may be a loop of bowel?